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<html xmlns="http://www.w3.org/1999/xhtml">
	<head>
		<meta http-equiv="Content-Type" content="text/html; charset=UTF-8" />
		<meta http-equiv="X-UA-Compatible" content="IE=8" />
			<title><!--%nom_fonction%--></title>
			<link rel="stylesheet" type="text/css" href="../../css/main.css" />
			<link rel="stylesheet" type="text/css" href="../../sinistres/justificatif/list.css" />
			    <!--[if IE 7]>
            	<link rel="stylesheet" type="text/css" href="../../css/ie7.css" />
            	<link rel="stylesheet" type="text/css" href="form_ie7.css" />
            <![endif]-->
            
            <script language="Javascript">
                function declarer(choix)
                {
                    var declarSinistre = document.getElementById("declarSinistre");
        			declarSinistre.href = '<!--%url_declarer%-->' + choix ;

                }
            //-->
            </script>
	</head>
	<body>
		<div id="sf_menu1">
			<h3><!--%nom_module%--></h3>
			<div id="information_erreur" >
	        		<ul id="message">
	        			<!--%loop:messages%-->
	        			<li><!--%message%--></li>
	        			<!--%endLoop:messages%-->
	        		</ul>
			</div>
		</div>
		
		<div class="cleared"></div>
		
	<div class="corps1">
	
		<form action="<!--%edit_action%-->" method="post" name="form1" id="form1">
		<!--%loop:champ_input%-->
			<!--%if:isset($['label_input'])%-->
			<div class="form1">
				<span><!--%label_input%--></span>
			    <input type="text" name="<!--%input_name%-->" maxlength="<!--%maxlength%-->" class="<!--%class%-->" value="<!--%input_value%-->" style="width:180px" size="50" />
				    <div class="bt">
				        <span class="btleft"></span>
				        <input type="submit" name="Rechercher" value="Rechercher" class="resizeall btmiddle"/>
				        <span class="btright"></span>
			        </div>
			        
			</div>
			<!--%endIf%--> 
							
		<!--%endLoop:champ_input%-->
	</form>
	<div class="cleared"></div>
	<div id="br"></div>			
	
	<div class="imgleft2"></div>
	<div class="imgmiddle2">
		<div class="btn">
        	<span class="btnleft"></span>
            <span class="btnmiddle"><h5><!--%nom_fonction%--></h5></span>
            <span class="btnright"></span>
        </div>
		<div class="btn1">
        	<span class="btnleft"></span>
            <span class="btnmiddle"><h5><!--%nom_liste%--></h5></span>
            <span class="btnright"></span>
        </div>
      
       	<table class="tab_liste">
		  <tr id="niv1">
		  	<td class="col1">&nbsp;</td>
			<!--%loop:colonne%-->
		    <td class="col<!--%num_colonne%-->"><!--%nom_colonne%--></td>
		    <!--%endLoop:colonne%-->
		  </tr>
		</table>
		<div class="content_table bright">
			<table class="tab_list">
			<!--%loop:tablist%-->
				<tr id="niv2" <!--%if:isset($['color'])%-->class="colorligne"<!--%endIf%--> >
				    <td class="col1">
				    <input onClick="declarer(this.value);" type="radio" name="choix" id="choix" value="<!--%id_ligne%-->" />
				    </td>
				    <!--%if:isset($['num_colonne_2'])%-->
				    <td class="col<!--%num_colonne_2%-->"><!--%val_ligne_2%--></td>
				    <!--%endIf%-->
			      	<!--%if:isset($['num_colonne_3'])%-->
			      	<td class="col<!--%num_colonne_3%-->"><!--%val_ligne_3%--></td>
			      	<!--%endIf%-->
			      	<!--%if:isset($['num_colonne_4'])%-->
			      	<td class="col<!--%num_colonne_4%-->"><!--%val_ligne_4%--></td>
			      	<!--%endIf%-->
			      	<!--%if:isset($['num_colonne_5'])%-->
			      	<td class="col<!--%num_colonne_5%-->"><!--%val_ligne_5%--></td>
			      	<!--%endIf%-->
			    </tr>
			<!--%endLoop:tablist%-->
			</table>
		</div>
		
		<div id="buttonright">
		<span class="btleft"></span>
		<span class="btmiddle"><a id="declarSinistre" href="#">Résultat</a></span>
		<span class="btright"></span>
		</div>
		
	 </div>
    <div class="imgright2"></div>    
    <div class="cleared"></div>
	
	<div class="bt1 retour">
		<a href="<!--%url_retour_fonction%-->">
	    	<span class="btleft"></span>
	        <span class="btmiddle">Retour</span>
	        <span class="btright"></span>
	    </a>
	</div>
	
	<!--%endIf%-->
	</div>

	</body>
</html>
